Potential New Biomarker
Abstract 0580: Talukdar et al.6
Transcriptomic analysis of peripheral blood cells is a powerful biomarker approach that can generate an abundance of information on the transcriptomic profile of lymphocyte and monocyte populations. The amount of data is truly “big.” One goal of transcriptional analysis is the development of predictive biomarkers to characterize treatment responders and non-responders, with the eventual goal of matching the patient to the most effective drug. The study by Talukdar is a step in this direction for patients with axial spondyloarthritis. Although the study involved only 21 patients, the use of single-cell RNA-seq and a Nanostring gene expression array showed some notable findings. Among biologic naive patients, non-responders had a lower proportion of T cells and higher proportion of monocytes than responders. Other notable differences related to the relative upregulation of interferon-regulated genes in non-responders. After treatment, a decrease in chemokines and cytokines levels was observed in responders.
As in the case of all new biomarkers, validation is essential and only time will tell how immunophenotyping will fit into personalized medicine approaches to optimize therapy.
Axial Spondyloarthritis Patients with Comorbid Fibromyalgia
Abstract 0561: Brink et al.7
Just about every form of inflammatory arthritis has a significant proportion of patients who fail to respond to conventional therapy and display persistent generalized pain and impaired quality of life. In these patients, fibromyalgia (FM), a condition of nociplastic pain with central sensitization, is a possible cause. In a cohort of axSpA patients, both radiographic and non-radiographic variants, Brink et al. assessed the prevalence of FM and its impact of patient outcomes.
As the data indicated, the prevalence of FM was 9% overall, with 17% in women and 2% in men. FM was also associated with a higher BMI and HLA-B27 negativity. Those with FM also showed more tender joints, worse disease activity, more functional limitations, less employment and lack of treatment response to more DMARDs. Although FM can be designated as a co-morbidity, its frequency among patients with inflammatory arthritis is so high that it appears to be an intrinsic feature of disease. Assessing FM can be accomplished by questionnaires, physical findings and quantitative sensory testing. These are straightforward approaches that seem very worthwhile to personalize the treatment approach using both pharmacologic and non-pharmacologic means.
Spinal & Hip Mobility in Patients with axSpA & Chronic Back Pain
Abstract 0544: Bento da Silva et al.8
